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Programme Partnership Arrangement

Scoping exercise in Sierra Leone for improved health systems


In mid-2015, Malaria Consortium began to look into the potential of starting up projects in Sierra Leone following the Ebola crisis of 2014-2015.

Sierra Leone is a country of approximately six million people in West Africa and, as a result of a protracted civil war which ended in 2001, it is considered one of the least developed countries in the world. Before the Ebola crisis, it was listed 183 out of 187 countries on the Human Development Index.

The disease burden is also heavy, with high levels of maternal and child mortality, and year-round malaria transmission. The Ebola crisis further weakened health systems and has resulted in a loss of over six percent of the qualified health workforce, less availability of government funds for health expenditure, lower access and uptake of routine health services, increased cases of ‘routine’ diseases such as malaria. It also resulted in a loss of trust and confidence in the health system.

Factors that led to the Ebola outbreak include poor or non-existent disease surveillance systems (including community surveillance), weak community health systems, poor availability and quality of health services in rural and remote areas, poor accountability in the health system, ineffective health system strengthening initiatives and preference for traditional healthcare over the formal health system.

These are areas in which Malaria Consortium has expertise and as a result, we carried out a scoping visit to explore the potential for establishing programming to complement and support Sierra Leone’s recovery phase, and to build relationships with key Ministry of Health and Sanitation (MoHS) stakeholders and in-country donors.  

Main findings

  • Sierra Leone has considerable needs following the Ebola crisis - particularly in malaria, community health, and data management and surveillance.
  • Key donors for health during the recovery period include the Department for International Development/UK aid, which will likely include working with implementing partners.
  • While there is much international interest in Sierra Leone at the moment, with many organisations carrying out scoping visits and some placing some staff in strategic positions (such as technical advisors for the MoHS), it is clear that Malaria Consortium’s particular expertise would be a welcome addition by donors and MoHS personnel.
  • Major health system gaps that could be addressed by Malaria Consortium include:
    • Data collection, management and surveillance systems
    • Community engagement and mobilisation (including surveillance)
    • Technical support to the National Malaria Control Programme
    • Implementation of a new community health worker strategy, including the expansion of integrated community case management
    • Capacity building of health workers, mainly in malaria
    • Building of laboratory capacity, especially in diagnosis of malaria

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